The CTSN was launched in 2007 to develop and conduct studies, mostly controlled randomized trials, to evaluated surgical interventions and related management approaches, for the treatment of cardiovascular diseases. The network was established to provide the rigorous evidence upon which key clinical treatment strategies could ultimately be based. However, the clinical research enterprise is generally challenging and frequent difficulties with patient recruitment, as well as retention into trials are experienced. I is well known that surgical trials are especially challenging for a variety of reasons. The CTSN has not been immune to such difficulties and although current trials are anticipated to complete enrolment within the initial grant budget, there remains a strong need for better approaches to identify, recruit, randomize, and retain patients and logistically manage cardiothoracic surgical trials. Thus, the object of this funding opportunity announcement is to solicit for experienced Core Clinical Centers that propose innovative strategies to successfully operate trials within the preview of the CTSN.